Anesthesia Induced Atelectasis
Conditions
Brief summary
Ventilated Patients especially those undergoing upper abdominal surgeries are prone to lung atelectasis. They are at risk of adverse effects secondary to inadequate lung ventilation. Applied PEEP and Recruitment maneuver are thought to enhance lung aeration under general anesthesia which could be assessed by ultrasound.
Detailed description
The aim of our study is to assess the effect of using PEEP with and without recruitment maneuver on atelectasis and lung aeration during open upper abdominal surgeries by ultrasonography. Application of PEEP improves intraoperative oxygenation and thus could minimize the incidence of postoperative atelectasis and respiratory complications during abdominal surgeries. A recent study found that PEEP and RM prevented intraoperative aeration loss, which didn't persist after extubation when comparing effects of positive end-expiratory pressure/recruitment maneuvers with zero end-expiratory pressure on atelectasis during open gynecological surgery by ultrasonography
Interventions
PROCEDURELow PEEP
Patients will be ventilated with a PEEP of 4 cm H2O and no RMs throughout the study
PROCEDUREHigh PEEP
PEEP of 10 cm H2O will be applied
PROCEDUREHigh PEEP/RM
PEEP of 10 cm H2O and RM (30 cm H2O for 30 s) immediately after the second lung ultrasonographic examination and repeated every 30 minutes till emergence
DEVICELung ultrasonogrphy assessment
The thorax will divided into 12 quadrants, each of them will be assigned a score of 0-3 as 0, normal lung sliding with fewer than three single B lines 1. three or more B lines 2. coalescent B lines 3. consolidated lung. The LUS (0-36) will be calculated with higher scores indicating more aeration loss
Sponsors
Mansoura University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
DOUBLE (Subject, Outcomes Assessor)
Masking description
Double-blind (Participant, Outcomes Assessor).
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* American Society of Anesthesiologists' physical status grades I, II, and III.
Exclusion criteria
* Patient refusal. * Psychiatric diseases. * Body Mass Index \> 35 Kg/m2. * Previous intrathoracic procedures. * History of severe obstructive pulmonary disease. * History of severe restrictive lung disease. * Pulmonary arterial hypertension ( systolic pulmonary arterial pressure \>40 mmHg). * Pregnancy.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Pre-emergence LUS score | intraoperative before recovery from anesthesia | Lung ultrasonography score (LUS score) between groups at the end of surgery (just before emergence) as a lower LUS indicates better lung aeration. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Heart rate | preoperative, intraoperative for anesthesia duration to 1 hour postoperative | heart rate between groups at each time point of LUS score performance |
| Mean blood pressure | preoperative, intraoperative to 1 hour postoperative | mean arterial blood pressure between groups at each time point of LUS score performance |
| oxygen saturation | preoperative, intraoperative to 1 hour postoperative | patient oxygen saturation between groups at each time point of LUS score performance |
| End-tidal carbon dioxide tension | intraoperative for anesthesia duration | end tidal CO2 between groups post induction, post recruitment and before extubation |
| Lung ultrasonography score (LUS score) | preoperative, intraoperative for anesthesia duration to 1 hour postoperative | Lung ultrasonography score (LUS score) between groups |
| Arterial partial pressure of carbon dioxide (PaCO2) | Intraoperative and 15 min postoperative | arterial blood gases post induction, before extubation and at the PACU |
| PaO2/FiO2 | Intraoperative and 15 min postoperative | arterial blood gases post induction, before extubation and at the PACU |
| Peak inspiratory pressure | intraoperative for anesthesia duration | peak inspiratory pressure between groups after intubation |
| Postoperative pulmonary complications (PPCs) | 5 days | PPCs include (pneumothorax, pleural effusion, pulmonary collapse, atelectasis, pneumonia, acute respiratory distress syndrome (ARDS), or pulmonary aspiration). |
| Arterial partial pressure of oxygen (PaO2) | Intraoperative and 15 min postoperative | arterial blood gases post induction, before extubation and at the PACU |
Countries
Egypt
Outcome results
None listed